Acral persistent papular mucinosis is a subtype of the localized papular mucinosis. Clinically, ivory to flesh-colored papules develop exclusively on the back of the hands, the extensor surface of the wrists, and occasionally the distal forearms. Histologically, mucin accumulates in the upper reticular dermis, typically sparing a subepidermal zone and fibroblasts are not increased in number. On experiencing a case of numerous papules on both hands and forearms of a fifty year-old woman, we present it as acral persistent papular mucinosis.
Dermis ; Female ; Fibroblasts ; Forearm ; Hand ; Humans ; Mucins ; Scleromyxedema* ; Wrist

Purpose: The electronic frailty index (eFI), which is derived from electronic health records, has been recommended as screening tool for frailty due to its accessibility and ease of use. The objective of this systematic review was to identify the prevalence of frailty assessed by the eFI and its influence on health outcomes in older adults with chronic diseases. Methods: We searched PubMed, Embase, Web of Science, CINAHL, SCOPUS, Cochrane, Google search, and nursing journals in Korean from January 2016 to December 2022. Results: Twelve studies were analyzed. The eFI score, based on routine clinical data, was associated with adverse health outcomes. The most frequent outcome studied was mortality, and the eFI was associated with increased mortality in nine studies. Other outcomes studied included hospitalization, length of stay, readmission, and institutionalization in relation to hospital care usage, and cardiovascular events, stroke, GI bleeding, falls, and instrumental activities of daily life as health conditions. Conclusion Early identification of frailty in older adults with chronic diseases can decrease the burden of disease and adverse health outcomes. The eFI has a good discriminative capacity to identify frail older adults with chronic diseases.

PURPOSE: The aim of this study was to evaluate the utility of contrast-enhanced MRI with first-pass and delayed images in prediction of myocardial viability after acute myocardial infarction. MATERIALS AND METHODS: Ten patients (M:F=:4, mean age =6 5 years) with acute myocardial infarction underwent first-pass image after bolus injection of gadolinium (one image/sec for 120sec)and delayed image (7 2 minutes later). According to 60 segments on midventricular level, the assessment of MRI were concerned about location of lesion, depth of lesion, enhancement on first-pass image and enhancement pattern on delayed image. MRI findings were compared with wall motion on resting echocardiography and stress or follow-up echocardiography. RESULTS: 1) MRI findings were classified into 4 types: normal enhancement on first-pass and delayed images (type 1), normal enhancement on first-pass image and nontransmural hyperenhancement on delayed image (type 2), non-transmural enhancing defect on first-pass image and transmural enhancement with endocardial non-enhancing defect on delayed image (type 3), and transmural enhancing defect on first-pass image and transmural hyperenhancement on delayed image (type 4).2) Type 2 suggested viable myocardium and type 3 had high porbability of viability. Type was compatible with non-viable myocardium. CONCLUSION: Enhancing defect on first-pass image and involving thickness on both the first-pass image and delayed image in contrast enhanced MRI may predict myocardial viability.
Echocardiography ; Follow-Up Studies ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction* ; Myocardium

The aim of this study is to evaluate the effect of viscoelastic substance on corneal thickness, corneal endothelium and intraocular pressure by measuring corneal thickness, corneal endothelial cell density and intraocular pressure in extracapsular cataract extraction with posterior chamber lens implantation. The study comprised of 50 patients, divided into two groups: extracapsular cataract extraction with posterior chamber lens implantation using Healon(R) or 2% methylcellulose(Metrol(R)). The txtracapsular cataract extraction was done by irrigation and aspiration technique and the posterior chamber lens was implanted into posterior chamber. The corneal thickness and endothelial cell density were measured preoperatively and at 6 weeks of postoperative period: intraocular pressure was measured preoperatively and at 24 hours of postoperative preiod. The results were as follows: 1. The preoperative corneal thickness, endothelial cell density and intraocular pressure were 499 +/- 34 micrometer, 2523 +/- 388 cells/mm2 and 15.9 +/- 2.4mmHg in average respectively. 2. The postoperative corneal thickness with Healon(R) was 501 +/- 42 micrometer, and with Metrol(R) was 491 +/- 28 micrometer. There was no significant difference between Healon(R) used and Metrol(R) used group(p<0.05). 3. The loss of endothelial cell with Healon(R) was 10.7%, and with Metrol(R) was 17.1%. The endothelial cell loss was lower in Healon(R) used group than that of Metrol(R) group. 4. The intraocular pressure with Healon(R) was 14.6 +/- 3.9mmHg, and with Metrol(R) was 12.3 +/- 4.4mmHg. There was no significant difference between Healon(R)-used and Metrol(R)-used group(p<0.05).
Cataract Extraction* ; Cataract* ; Cornea* ; Endothelial Cells ; Endothelium, Corneal ; Humans ; Intraocular Pressure* ; Postoperative Period

Parkinsonism is a clinical syndrome presenting with bradykinesia, tremor, rigidity, and postural instability. Nonmotor symptoms have recently been included in the parkinsonian syndrome, which was traditionally associated with motor symptoms only. Various pathologically distinct and unrelated diseases have the same clinical manifestations as parkinsonism or parkinsonian syndrome. The etiologies of parkinsonism are classified as neurodegenerative diseases related to the accumulation of toxic protein molecules or diseases that are not neurodegenerative. The former class includes Parkinson’s disease (PD), multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. Over the past decade, clinical diagnostic criteria have been validated and updated to improve the accuracy of diagnosing these diseases. The latter class of disorders unrelated to neurodegenerative diseases are classified as secondary parkinsonism, and include drug-induced parkinsonism (DIP), vascular parkinsonism, and idiopathic normal-pressure hydrocephalus (iNPH). DIP and iNPH are regarded as reversible and treatable forms of parkinsonism. However, studies have suggested that the absence of protein accumulation in the nervous system as well as managing the underlying causes do not guarantee recovery. Here we review the differential diagnosis of PD and parkinsonism, mainly focusing on the clinical aspects. In addition, we describe recent updates to the clinical criteria of various disorders sharing clinical symptoms with parkinsonism.

BACKGROUND AND PURPOSE: We investigated subsequent vascular events in patients with transient ischemic attack (TIA) and determined the predictors of such events among vascular risk factors including large-artery disease, TIA-symptom duration, and acute ischemic lesions on diffusion-weighted imaging (DWI). METHODS: We identified 98 consecutive patients with TIA who visited a tertiary university hospital and underwent DWI and brain magnetic resonance angiography within 48 hours of symptom onset. We reviewed the medical records to assess the clinical characteristics of TIA, demographics, and the subsequent vascular events including acute ischemic stroke, TIA, and myocardial infarction. RESULTS: Large-artery disease was detected in 55 patients (56%). Ten patients (10%) experienced TIA symptoms for longer than 1 hour, and acute infarctions on DWI were identified in 30 patients (31%). During the mean follow-up period of 19 months, seven patients (7%) had an acute ischemic stroke and 20 patients (20%) had TIA. Retinal artery occlusion in two patients, spinal cord infarction in one patient, and peripheral vascular claudication in one patient were also recorded. Cox proportional-hazards multivariate analysis revealed that large-artery disease was an independent predictor of subsequent cerebral ischemia (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.1-7.1; p=0.02) and subsequent vascular events (HR, 2.9; 95% CI, 1.2-6.7; p=0.01). CONCLUSIONS: In patients with TIA, large-artery disease is an independent predictor of subsequent vascular events. Acute infarction on DWI and a symptom duration of more than 1 hour are not significantly correlated with a higher risk of subsequent vascular events. These findings suggest that the underlying vascular status is more important than symptom duration or acute ischemic lesion on DWI.
Brain ; Brain Ischemia ; Constriction, Pathologic* ; Demography ; Follow-Up Studies ; Humans ; Infarction ; Ischemic Attack, Transient* ; Magnetic Resonance Angiography ; Medical Records ; Multivariate Analysis ; Myocardial Infarction ; Prognosis ; Retinal Artery Occlusion ; Risk Factors ; Spinal Cord ; Stroke

PURPOSE: Anaplastic thyroid carcinoma is characterized with rapid growing mass of the neck and early infiltration into the surrounding tissue. Because of its advanced presentation in elderly patients with poor general condition, difficulty in diagnosis and lack of effective treatment, it is one of the most lethal cancers in human. The aim of this study was to investigate the clinicopathologic character of anaplastic thyroid carcinoma and analyze the prognostic factors affecting survivals. METHODS: Twenty patients diagnosed anaplastic thyroid carcinoma in Seoul National University Hospital between 1985 and 1999 were reviewed retrospectively. RESULTS: The most common symptom was a rapidly enlarging neck mass. Ten (55.5%) of 18 patients had a concomitant well differenciated thyroid carcinomas and 5 (27.8%) patients had benign thyroid disease on pathologic features. The median survival was 5.5 months and the 2-year survival rate was 27.3%. Among several factors analyzed, tumor size smaller than 5 cm (p<0.001), absence of distant metastases at presentation (p=0.020), patients selected for curative surgical resection (p=0.002), and postoperative radiotherapy (p=0.003) were associated with prolonged survival time. CONCLUSION: In the selected patients(tumor size <5 cm, the absence of distant metastases at presentation, young age (<55), curative surgical resection and adjuvant radiotherapy may be associated with an increased survival time.
Aged ; Diagnosis ; Humans ; Neck ; Neoplasm Metastasis ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Seoul ; Survival Rate ; Thyroid Carcinoma, Anaplastic* ; Thyroid Diseases ; Thyroid Neoplasms

PURPOSE: The purpose of this study was to determine the relationship between dorsal metaphyseal comminution and the radiographic and functional outcomes of patients with distal radius fractures treated by closed reduction and cast immobilization. METHODS: Twenty-six patients with acute distal radius fractures were retrospectively reviewed. The mean age of this patient group was 62.8 years (range, 45-87 years). Eighteeen cases were AO type-A3 and 8 were AO type-A2. Radiographic and functional parameters were analyzed and compared between the patients who presented with or without dorsal metaphyseal comminution on their initial radiographs in order to assess the clinical outcomes. The radiographic parameters included radial inclination, radial length, volar/dorsal tilt, and ulnar variance. In order to measure the functional outcomes, each patient's range of motion, grip strength, Quick disabilities of the arm, shoulder, and hand (DSAH), visual analog scale (VAS), and Mayo score were determined. RESULTS: Seventeen patients (65%) presented with dorsal metaphyseal comminution on the initial radiographs. Radial inclination, radial length, and volar/dorsal tilt were decreased and ulnar variance was increased on the final radiographs in comparison with the postreduction. However, there were no statistically significant differences between the two groups that presented with or without dorsal metaphyseal comminution (p>0.05). None of the functional parameters (i.e., range of motion, grip strength, DASH, Mayo, and VAS score) were significantly different between the two groups (p>0.05). CONCLUSION: Dorsal metaphyseal comminution seems to have no significant impact on radiographic and functional outcomes when closed reduction and cast immobilization was planned for the treatment of distal radius fracture.
Arm ; Hand ; Hand Strength ; Humans ; Immobilization ; Radius ; Radius Fractures ; Range of Motion, Articular ; Retrospective Studies ; Shoulder

BACKGROUND/AIMS: The endoscopic injection therapy with hypertonic saline-epinephrine(HSE) and absolute ethanol are the most widely and easily used procedure in the management of patients with bleeding peptic ulcers. We performed a prospective, randomized trial to compare the hemostatic efficacy between HSE and absolute ethanol injection therapy. METHODS: During the period of 1993 to 1996, 60 patients who were identified as active bleeding or visible vessel were enrolled for this trial. The 60 patients were randomly divided into two groups(HSE group, 30 cases: ethhnol group, 30 cases). We performed endoscopic injection therapy with 3% saline and 1:10,000 epinephrine solution in HSE group, and with 99.5% absolute ethanol in ethanol group. The two groups were matched for sex, age, site of bleeding, endoscopic findings, initial hemoglobin, and concomitant illness at randomization. RESULTS: Bleeding was initially controlled in 21(70%) of the HSE group and in 29(96.7%) of the ethanol group(p < 0.05). Rebleeding occurred in 4(19%) of the HSE group and in 2(6.9%) of the ethanol group(p < 0.1). The ethanl group achieved a better hemostatic effect for spurting hemorrhage(3/13 vs 9/10, p < 0.05). The emergent operations were undergone in 10(33.3%) and 2(6.7%) for HSE group and ethanol group respectively(p < 0.01). The stay in hospital were less than in ethanol group(mean 9.5 vs 16.3, p < 0.01). The death were noticed in 6 cases(20%) in HSE group and 1 case(3.3%) in ethanol group(p < 0.05). CONCLUSIONS: This study shows that absolute ethanol injection is more efficaceous and better satisfactory method in peptic ulcer bleeding.
Epinephrine ; Ethanol* ; Hemorrhage* ; Humans ; Peptic Ulcer* ; Prospective Studies ; Random Allocation

BACKGROUND: The catheter ablation usin radiofrequency(RF) energy in patients with atrioventricular nodal reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT) ahs been proved as a safe and effective nonpharmacologic therapeutic modality. The purpose of our study was to evaluate the success rate and complications of the initial experience and to determine the extent of myocardial damage of RF catheter ablation. METHODS: Electrophysiologic study was performed with the standard technique. Twenty five patinents(M:F=16:9, mean age:42 years old) underwent RF catheter ablation in St. May's Hospital from April to December in 1994. The RF generator in this study was RFG-3D model and catheters were 6F or 7F steerable catheters with 4mm kistal tip. In order to evaluate the extent of myocardial damage the WBC count, LDH, CK, and CK-MB fraction were checked before and after RF catheter ablation and the Tc99m myocardial scintigraphy was performed within 72 hours of the porcedure. RESULTS: Six of twenty five patients had AVNRT, in which the success rate of selective ablation of the slow pathway was 83.8%. Nineteen patients with AVRT had one accessory pathway. The ablation success rate of 14 accessory pathways in left free wall location was 85.7%, and that of 3 in left posteroseptal location was 66.6%. Two right sided accessory pathways were not ablated successfully. The level of CK-MB fraction after ablation was within normal limit. Only one case revealed grade 2 of hot spot in Tc99m myocardial scintigraphy. CONCLUSION: The RF catheter ablation in patients with AVNRT and AVRT is a safe and effective nonpharmacologic therapeutic modality. But right sided accessory pathways are more difficult to ablate than left sided accessory pathways, requiring more experiences and better technique. The extent of myocardial damage after RF catheter ablation reveals relatively minimal by cardiac enzyme study and Tc99mmyocardial scintigraphy.
Catheter Ablation* ; Catheters ; Humans ; Myocardial Perfusion Imaging ; Radionuclide Imaging ; Tachycardia, Supraventricular*